Provider Demographics
NPI:1174620850
Name:PEARSON, MADORA DORIE MASON (OTR)
Entity type:Individual
Prefix:MRS
First Name:MADORA DORIE
Middle Name:MASON
Last Name:PEARSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4824 MCKNIGHT RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-0935
Mailing Address - Country:US
Mailing Address - Phone:903-793-6135
Mailing Address - Fax:903-793-0053
Practice Address - Street 1:4824 MCKNIGHT RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-0935
Practice Address - Country:US
Practice Address - Phone:903-793-6135
Practice Address - Fax:903-793-0053
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 235Z00000X
TX107168225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046679OtherUNITED HEALTHCARE
TX1257421OtherCIGNA AMERICAN SPECIALTY HEALTH
AR122049721Medicaid
TX004487703Medicaid
TX871T52OtherBCBS
TX004487701Medicaid
TX004487704Medicaid
TX8T6174OtherBCBS